Retinoscopy and accommodative spasms

A common retinoscopy mistake is over-minusing the patient due to accommodative spasms. When performing ret, always look for clues of these spasms by monitoring any fluctuations in the pupil size, axes of the meridians, and the speed and brightness of your streak. When working with young patients especially, be sure to avoid ‘over-fogging’ them and making their target too blurry, as this may tend to increase their accommodation to a tonic state. By limiting fogging lenses to about 2D from the patient’s neutral point, you can ensure the patient can discern some detail in the target and better control their accommodation, giving you much more reliable results.